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Tuesday, April 24, 2012

Non-Stress Test: Totally Stressful

Yesterday, I was so ready to rock the nonstress test. Deuce had been moving like a champ all weekend long. I was feeling confident. All your blog comments assured me I would enjoy the NST! I was going to hear the baby and watch the heartrate and just hang out doing nothing for thirty minute to an hour. Sounds awesome!

The one bummer was that I had to have a blood draw done before the non-stress test (just to double check my iron levels) AND David couldn't be there for the blood draw part of it (but would be able to meet me for the NST). Rather than reschedule the blood draw for another day, I decided to buck up and just get it done on my own (so brave, right?).

Blood draw went fine--no drama. It was a painless stick and took about 2.2 seconds. I was very impressed with her needle skillz. (My OB later told me that this phlebotomist worked at his old office and she was the one he'd have do his own bloodwork because she's the best.)

High on the rush of my own success in not crying or passing out while having blood drawn, I headed downstairs to the maternal fetal medicine center to sign in for my nonstress test. The Deuce and I were going to ROCK this! They called me back ahead of schedule, but David showed up just in time.

I sat down in a blue hospital-style recliner and they pulled a curtain for privacy and took my blood pressure and then hooked me up. I had two monitors put on my belly--one to track the baby's heartrate, and one to measure uterine contractions.

My tech was pleasant enough, although she did say, "And we're monitoring for..." (flips through file) "uh, do you know why you're being monitored?"

(annoyed pause on my end) "Uh, yeah. Because my first baby DIED."

OK, really I gave her a few more details than that, and didn't shout the word "DIED" at her, but I was also thinking, "Could you fucking make a note of that in the front of my file? Because I don't know why I have to hash this out with you people and explain to you WHY my doctor is sending me here every freaking time I show up."

Anyway, the tech was also pregnant which made me feel really awkward. And also slightly resentful? Not particularly nice or rational of me, but what can I say? It is what it is.

So anyway, I told her I was nervous since this was my first NST and she nicely explained what they were looking for--they'd find the baseline heart rate and then watch to see that it accelerated by 15 beats twice in 15 minutes. This indicates that the baby is moving and shaking in there, and that the heart is keeping up. She said that they keep people on the monitor for 30 minutes or longer if necessary, and that since my baby is so young, it might take longer. (I'm just at 30 weeks and these tests normally start at 32 weeks, but since my loss occurred at 34 weeks, my doctors want to start gathering data on the Deuce now.) She said that she'd keep an eye on things from the nurse's station and she'd come back and have me move around if necessary. Then she left.

It was just David and me and the sound of the Deuce's heartbeat, which David remarked sounds just like the bridge at Silver Dollar City where you hear the sounds of galloping hooves as you're walking across it. I had David take this picture of me.

Still having fun about 10 minutes in.

Time passed. And kept passing.

The Deuce, however, did not pass.

No one used the words "pass" or "fail" with me at all today, but I was watching the monitor pretty closely, and I sure as hell wasn't seeing accelerations at the rate of 15 beats a minute. Sure, it was going up and down and making a nice little zig-zaggy pattern on the print out. But I knew that it wasn't meeting the NST requirements.

The rational part of my mind KNEW that this was somewhat typical for a 30-weeker. My friend Angie had told me that young babies tend to fail the nonstress test. She's smart and experienced and well-informed and I totally trust her opinion. And YET, it was freaking me out.

I needed the tech to say something reassuring. Instead, she came in, said something about this baby being "sleepy" and had me turn on my left side. Sat for a while with us (saying NOTHING, just SILENT and all pregnant and judgy) and then had me turn on my right side. Then she left again and said she'd be back. I told David he had to ask her if we needed to be worried because I couldn't say it without crying. Then I started crying anyway.

By this time, I'd already been on the monitors for an hour.

So she came back, David asked if there was any reason for us to be concerned. She immediately said no, but TOO LATE. I was already freaked out.

She left again, and then another tech came in, and that scared me because I thought she had to go and get a more experienced tech because something was wrong. (I just make up these narratives in my head, but they SEEM true at the time.)

The second tech asked me how I was doing and I said "Fine" because I wasn't in any physical pain or anything (I mean, is that what she meant? I have no idea.), but I was doing everything I could not to really start crying because I KNEW my baby was failing this test. This second tech gave me some pillows to make me more comfortable, and told me to relax so that the baby had lots of room to move without my abdominal muscles being tense (you know because my ab muscles are so AMAZING that it must be my six pack that's preventing the baby from passing this test). She was super nice, but I had been in that stupid recliner for over an hour and I was so over it.

She told me just five minutes more and then left and then I cried.

She came back and didn't say the baby has failed (but I KNEW that's what she was thinking). She told me, very kindly, that I could go to the bathroom if I needed to and then she'd do a bio physical profile on the baby. She still wasn't using the word "failed" and she said a lot of stuff about how 30-week baby sometimes just aren't ready to perform everything this test wants them to do, but by 32 weeks they're ready. I understood what she was saying, but it didn't matter.

I went to the bathroom and cried. I could feel the baby moving, and I'd been listening to the heartrate for over an hour, so I knew the Deuce was alive, but I was just so scared that things weren't ideal, that something was wrong, that there was an indication of a problem no one was telling me about yet, that in another month, we'd look back and see that this was the beginning of the end.

And of course, I kept thinking about Eliza, wondering if she would have had the same lack of heart acceleration, wondering if this would have been the indication that something was going terribly wrong for her...

(My therapist tells me that making up my own disturbing narratives like this, based on zero facts or reliable information, is really not a great use of my brain power. But my brain does not always listen to my therapist.)

David called my OB to tell him that we were going to be late for our 4:30 appointment because at this point it was almost 4:30 and we were just now starting the biophysical profile. The second tech took us to the ultrasound room for the BPP. She explained that for this test, the baby had thirty minutes to make three movements, demonstrate tone three times (like flexing muscles), and practice breathing twice for thirty seconds each time. The test would also measure my fluid level. My understanding is that each of those four elements contributes 2 points to the overall score, with the NST also being worth two points. So a perfect score is 10.

The Deuce and I had already blown that with a 0/2 for the NST, so we were shooting for 8 out of 10 possible points. It's a B-, but, I told myself, still a respectable score.

My heart started racing. C'mon Deuce! We don't have test anxiety! We perform well under pressure! We love standardized tests! Show the nice lady how smart you are!

Sure enough, Deuce obediently squirmed around and the tech declared the movements "lovely," said my fluid level looked "excellent," and admired the Deuce's muscle tone. I knew she was just trying to make me feel better, but it worked. I eat up compliments for the Deuce.

Then there was the breathing practice. She explained that that we'd see the chest rock or move in a particular way, and the three of us (David, myself, and the tech) stared at the screen. I realized that I was clenching my fists as I was WILLING the Deuce to breathe with everything I had.

The Deuce did not give a shit. There was no breathing. Really, Deuce? Totally uncooperative? OMG do you not know how to BREATHE?

The tech helpfully explained that breathing is not necessary since the baby is getting oxygen from the placenta. It's just a reflex that they want to see the baby performing. (Which I sort of already knew since obviously I realize the baby is not exactly breathing in the womb, but it was still comforting to hear.)

Then ANOTHER tech came in the room and that freaked me out (calling in reinforcements! because there is an emergency! I'm just the last to know!). Then the second tech explained that her shift was up but she'd wanted to get me started, and this tech was going to finish up. We were halfway through the 30 minute limit at this point. Nothing was wrong, but my imaginary emergency narrative had gotten me started crying again, though, so the second tech got me some kleenex before she left. I was a hot mess.

Fortunately, third tech was as wonderful as second tech. In five minutes, she talked us through everything, and explained that the Deuce had passed the tone and movement elements again in the short time she'd been there, so that was very encouraging. She said that the baby was taking some breaths but she needed to see it happen for thirty seconds. I was feeling a little calmer then since it wasn't that my baby was incapable of breathing, but just didn't feel like doing it for extended periods of time. She also assured us that it made no difference if the baby passed the BPP in five minutes or thirty minutes. Equally good score and no need to worry either way.

We all stared at the screen some more. The Deuce kicked his/her feet. Waved his/her arms. Looked with an open eye at the camera. But STILL no breathing practice.

And FINALLY--just when I was about to ask what happens if the Deuce fails this part of the test, too--the Deuce quit screwing around and breathed for us.

Then David and I felt like we could breathe again. The tech was as happy as we were. I wanted to hug her.

So the Deuce got an 8/10 on the purple report card. The third tech explained that 8 and 10 are both considered very good scores. She insisted that they take these tests very seriously and they would not let us leave if there was any reason to be concerned.

She said that the rules aren't set in stone, but the general protocol that the doctors follow is that a 8 or 10 is good. 6/10 is considered "equivocal" and that would mean we'd need to come back in less than 24 hours for another test. A 4/10 would get me admitted to the hospital and a 2 or 0 would get that baby delivered right away.

I found this reassuring. Just to know they had a plan and that they would deliver my baby at 30 weeks before they'd let me go home if something was really wonky and the baby could be in danger. I mean, that's why we were there. To have lots of eyes on the Deuce.

I also privately thought that a B- was pretty freaking good for a 30 week baby taking a test meant for a 32 weeker. (Good job, Deucers. You're totally advanced for your age.)

Then the sonographer doctor (NOT the asshole one--THAT note is definitely in my file because we have not seen him since the 20 week meltdown) came in and told us the same thing the tech had said--score looks good, 30 weeks is often too young to meet the heartrate accelerations they're looking for, biophysical profile is great, no reason to be worried about the test today. I could have cried from relief, but I managed to hold it together. I was so exhausted that I didn't have any questions for him. I just wanted to see my doctor and then go home. Truth be told, I REALLY wanted to go home and have a glass of wine, but obviously that's off the table.

(The Deuce both drives me to drink and prevents me from doing it.)

By this time it was 5:00pm. I'd been in that department for for an hour and forty five minutes, and I was thirty minutes late for my OB appointment. The tech called my OB to tell him I was on my way up. She came back to tell us that his office was closed, so she had called his cell phone and he told her he was waiting for me. She said, "That goes to show what a nice guy he is." Which we already knew, but yes, he totally is.

We left the maternal fetal medicine center, feeling slightly dazed but mostly reassured, and headed up to my OB's office, who, nice guy that he is, made me feel much better. He was glad we got the BPP and said that it's good to have this data, even though it's early to do the NST monitoring. He was very pleased with the results overall.

Now we just have to make it through another week and we get to go back and do it all again! Let's just hope next time the non-stress test is a little less stressful. Otherwise they may need to hook ME up to the heart monitor.

24 comments:

There is a little sticky note in the front my chart at the perinatologist that says something like previous twin pregnancy with 24 week demise of presenting twin. May sound crazy, but maybe ask them to add one?

I'm nervous because my peri is starting BPPs at 28 weeks instead of 32 because of cord worries and they are likely to fail at that age. So, reading this story will hopefully help me calm.

Ah, yes. The stress. I found them both calming (physically hearing baby heartbeat nonstop) and maddening all at the same time. I needed them and wanted them everyday.

I started at 32 weeks but the MFM office didn't want to do so until 33 weeks because they said 32-weekers usually are too young and often "fail" these tests, too. B was scoring 8/10 between 34-36 weeks... hence the induction. Still good, but not freaking good enough for a woman who's lost a baby before at full term.

So proud of the Deuce and absolutely love your OB. You think it's worth the 4.5 hour drive to STL for his care during my next pregnancy? Keep him forever. He better not retire during your pregnancy years. I find it fascinating to see the differences-- I laid down during mine and watched television in my own room while listening to his heartbeat. Many people, like you, get recliners. I also hope the NSTs start to become more calming for you.

omg, i felt myself holding my breath the whole time. so glad everything turned out well, albeit stressful. sometimes it seems as if extra monitoring can cause more stress as well as providing reassurance. i remember that i scheduled a 36 wk u/s for our little girl, and left wishing i hadn't because at that age it's hard to get a good pic of them in there because they are so squished. and she was measuring small, because well she is a tiny girl, but all i heard the doc say was "there is something wrong with your baby." which he of course said nothing like that. what he said was "you've got a tiny little girl." sometimes it feels like you're damned if you do and damned if you don't.

Dude, I warned you! I thought about texting you yesterday and totally should have.

I had NST's from 28 weeks on. Almost every single one, Luke failed. Not only did he fail, but he would have sharp ugly decelerations for no reason...bad enough that it made our nurse Jenny worry about us all weekend and tell the next nurse to watch the monitors closely that Monday. He usually passed the bpp's (we had a lot of them and holy cow those suckers are expensive..like 1000+) but sometimes wouldn't breath for long enough either. The roll over, roll over, "drink some water" "drink some soda" stuff is all normal. There was one nurse that i really didn't like who i told no i was not going to roll over for, lol, because i knew it wouldn't help and by that point one of the doctors had said 'bpp after every nst until 32 weeks' because he'd failed so many nst's. And the fun culminated in such a bad nst (so bad that the nurse faxed them my test strip so they could see it for themselves instead of summarizing it), followed by a bad bpp, that our mfm told us to get to the hospital...then at 32 wks it was like a flip was switched and they were suddenly calling him a rock star and couldn't believe it was the same baby.

Some tips- eat something sugary about 20 to 30 min before it, even better if you drink something with caffeine in it too.

Also the ppl who do the nst's are nurses, there are some really nice ones and some i didn't care for. they will ask why you are being monitored pretty much every.frickin.time. This was why i liked doing them in o'fallon, it was usually the same few nurses, a short wait, etc.

At our MFM, they give a pass on NSTs for accelerations of just 10 bpm, if the baby is before 32 weeks. I know baby dragon would have been failing some tests (and therefore stressing me out) otherwise. She'll have the tougher standards (15 bpm accelerations) to live up to in a few weeks. So maybe the Deuce would have gotten an A+ here? Southern CA grade inflation :)

Also, we provided a note for our doctors to attach to the front of our file that has a picture and a short explanation about Elizabeth. It has helped - actually, it has totally eliminated the clueless questions.

Oh, God, Brooke. This took me back. I had so many miserable NSTs with Teddy. And when I had my first NST with Dot, it was really ugly. She passed - eventually (I think we were at 34 weeks) - but I didn't. My bp was through the roof and I could barely keep myself from running screaming from the room before it was over (not an exaggeration - I had a death grip on that chair). We also had a bad nurse. We requested never to have that nurse in the room with us again. Nervous laugh, clueless, condescending, patronizing - he was a nightmare.

One thing that really helped (and Wiley mentioned something very similar) - my doctor put a note (prominently) in my file for NSTs after that first ugly one. The note included my history and recommended a few things to help me cope with PTSD - I think she suggested that we get a few minutes to settle into the room before the NSTs started and also that the nurses let me know exactly what was going on as much as possible. It's a small hospital here, so it worked very well. I'm not sure how it would work in a bigger facility, but it might be worth a try.

I'm so glad you have a good OB. And I hope next week's NST is much more non stress than stress.

I agree with everyone - NSTs seem like they're going to be kind of fun (listening to that wonderful heartbeat while relaxing in a comfy chair!) but they're really not. We had a BPP with our oldest, which I know now he passed really quickly, but those minutes of waiting were brutal. So glad for you that the first one is successfully behind you and hope that all the others are easier on you.

I have a love/hate relationship with NSTs right now. I've been having them since 28 weeks. Davey has failed three of them (I go 2x per week).

The last one he failed, last week, was after I chugged a Dr. Pepper (from the nurse), ate Easter candy from the nurses' station, and both the doc and the nurse poked on my belly. He would get agitated when they poked on my belly b/c his little HR went up, but when they stopped poking he would just settle back down into chill mode and sit at about 132 bpm. No movement, no that was asking too much apparently.

And yeah, if I have a diff nurse, I always get the "wow! why are you doing NSTs so early?"

The first week I went for NSTs, I got the same question from the same nurse, 3 days apart.

Excuse me while I poke my eyes out. I had to talk to my doc about that one.

I mean, they have those horrible bereavement cards that they stick on our hospital doors. Can't they find that in sticker form and stick it on the front of our chart so we don't get asked stupid, unnecessary questions???

Sugar and caffeine don't work on my stubborn little guy. They make him fall asleep, esp sugar.

Why do they call it a NON-stress test anyway?? I'm betting that even parents who have never lost a previous baby find them stressful. :p (((hugs))) Here's hoping for something less stressful next time around.

Oh man, seriously stressful!! My mind would have done all the same things your's did. I am excellent at making catastrophes in my mind before anything actually occurs. So glad the first one is over and that the Deuce did well! Hoping the next ones are much easier!!

Firstly, off topic, I also love your shoes!Oh these tests. Gawd they are hard. We started at 33 weeks with Angus and he failed a few of them, sending me in to a tailspin. And the questions about "why are you in for monitoring today?" Dude. Please. Spend 30 seconds reading my file.This post soooo took me back. I hate those tests and I hate that we lost the innocence of our first pregnancies.xo

Phew. Stressful. For what it's worth, this little one I'm carrying didn't pass at 32 weeks. He scored a 6. By 34 weeks he was doing much better, but it always takes cookies, ice water, and nearly 45 minutes for him to pass. My oldest daughter needed the same when I was 41 weeks with her. We read a lot about false positives of NST's. It's so emotionally trying though. All the extra monitoring this pregnancy has meant a ton of extra fear and worry, although everything so far has turned out to be fine. But nearly every appointment there has been some potential cause for concern. It's exhausting, but I'm glad for the monitoring anyway. Sending hope your way for the Duece...- Kari

Holy crap, I swear...I feel like we're living the same pregnancy in two different cities!

First of all, congratulations on an overall successful NST and biophysical!! AND extremely successful blood draw (maybe the highlight of the whole experience, huh?)

Second, I love that David came for the appointment. What a guy. I mean, an hour to sit next to you and watch wiggly lines on a strip when he has no input, control and active participation...it's kind of boring! I was bored after 20 minutes and the baby was IN me!! But so touching that he wanted to be there for you and to listen to the Deuce's heartbeat.

Third, my 29 weeker didn't pass the NST either. Same as you, the staff never said she failed, just said it's 'early' for the accelerations they're looking for. Bleah. At one point her heart rate dropped off the monitor altogether which TOTALLY freaked me out. Still don't know why.

Fourth, our girl had the hiccups something fierce and I think it messed with the getting the breathing movements. Fun to watch but like you said - you just want the baby to cooperate so everything is PERFECT!

And last, god love your OB. Obviously you made a good choice in him. (I've missed so much having not checked out your blog in a few days! Love love catching up with it - always something heartbreaking, True, hilarious, and most of all Real. Thanks for ALL of it!)

Hi! I have no place to be posting here....I have no subsequent child. We have infertility issues. But I noticed that you had hypnobabies. I wonder if listening to that the next time you have a NST might be calming? If not hypnobabies maybe some other relaxation CD...? I hope my posting this is not over stepping.

It was comforting in a sick and twisted way to read your post. I lost my first and just started NST twice a week. I am 32 weeks. Little man failed both the NST and the BPP, and so starts the interminable 2 months of living 3 days at a time between tests. Seriously, how do you survive it?!